By: Jared Bridges, DPT
When it comes to dynamic activity of the body, one of the most important muscles to keep in shape is the gluteus medius. The gluteus medius is a fan shaped muscle that attaches at the top of your hip and inserts to the outside of your femur. The primary purpose of this muscle is to "abduct", or bring the leg out to the side of the body when the knee is straight. However, another purpose of this muscle is to act as a dynamic stabilizer of the hip and, in turn, the entire lower leg while walking. When this muscle does not function properly, it may cause a chain of events that lead to lower leg pain and dysfunction.
A kinetic chain refers to several structures of the body working together to perform an action. For instance, in this case we will be referring to the kinetic chain from the hip to the ankle and how those muscles and joints function in order to allow us to walk normally. As you walk you may notice that with each step you swing your arm in an alternating pattern. What you may not notice is the actions of each joint as you take those steps. Of key significance in this situation we will examine the hip. With each step that we take, the hip, or pelvis, rotates forward and backward in an alternating pattern corresponding with the foot that is striking the ground at that time. When the gluteus medius is not strong enough to control your pelvis and keep it level during walking, this may lead to a series of events that can not only cause hip pain, but also back, knee, and ankle pain as well. When this muscle is weak, it can cause your pelvis to "drop" during walking on the opposite side of the hip that is weak.
This dropping of the pelvis is known as the Trendelenburg sign and is one of the diagnostic tools used to assess weakness in the gluteus medius. When the pelvis drops, it causes the knee to rotate inwardly and the ankle to compensate by placing excessive stress of the middle aspect of the foot. You may walk for months or even years with these complications because your body will begin compensating for the dysfunction by creating abnormal movement patterns. These symptoms are often not treated until people start to develop pain, swelling, or discomfort at the back, knee, or ankle.
This situation is often overlooked in several common conditions of the lower extremities. Several such conditions include: shin splints, Achilles tendonitis, plantar fasciitis, and even tarsal tunnel syndrome. Common generalized treatments for some of these conditions include strengthening of the gluteus medius, specific training for decreased compensation during walking, and pain management techniques to facilitate proper healing of the painful area.
With that being said, not all of these conditions are caused by gluteus medius weakness, which is why a proper evaluation from a skilled Physical Therapist may be necessary to determine the exact nature and cause of the musculoskeletal pain. During this evaluation, the physical therapist will compile a list of impairments in order to develop an individualized treatment plan that is specific to each patient, and will enable them to return to their best potential.
So if you or someone you know would like to know more about physical therapy options for a variety of conditions, seek the consultation of a physical therapist at one of our five locations or see your physician for a referral to one of our facilities. For further information on this or other related topics you can contact Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, Jared Bridges, DPT ( Surfside), Jill Phelan, DPT (Conway) (843) 733- 3031 and (Murrells Inlet) (843) 314-3224 or Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN (Pawley's Island) (843) 235-0200 or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for your physician to fill out. You can also call and schedule a free 15-minute consultation!